What Is Privacy? Perceptions of Older Adults in the South of Spain

About the Concept of Privacy and in Terms of Video-Based AAL

Technologies

Tamara Mujirishvili

1 a

, Miguel Richart-Mart

ınez

1 b

, Julio Cabrero-Garc

ıa

1 c

and Francisco Fl

orez-Revuelta

2 d

Department of Nursing, University of Alicante, Ctra. San Vicente del Raspeig, S/N 03690 San Vicente del Raspeig, Spain

Department of Computer Technology, University of Alicante,

Ctra. San Vicente del Raspeig, S/N 03690 San Vicente del Raspeig, Spain

ﬂ

Keywords:

Privacy, Active Assisted Living Technologies, Camera-based Technologies, Life-logging, User-acceptance,

Older Adults, Video-monitoring, Qualitative Study, Exploratory Interviews.

Abstract:

Privacy is a very complex concept that concerns all areas of human activity. Even more so, it has acquired

whole new importance and has become a hot-button topic in the era of ubiquitous computing. The emer-

gence of Active and Assisted Living (AAL) technologies is offering the improvement of the quality of life

and maintaining the independence of older adults in their preferred environment. Especially with the advance-

ment of computer vision, video-based technological solutions are giving us promising results but bring along

signiﬁcant risks of privacy violation. With this qualitative study, we aim to explore older adults’ understand-

ing of privacy as a construct and their privacy considerations for technology-based monitoring applications

in eldercare, for video-based systems among them. Exploratory interview sessions were conducted with 12

older adults 66 and plus of age living in care homes and in private households. Findings indicate that the

concept of privacy is indeed difﬁcult to understand and deﬁne for older adults. However, the context of video

monitoring elicits clear privacy concerns. The nudity aspect of privacy was proved to be the most important

among the participants, yet, the attitudinal shift in the perception of nudity was observed in older adults living

in care homes. Eight out of 12 interviewed older adults did not like the idea of having a camera-based assistive

technology, however, some of their worries were alleviated after explaining to them the possible technology’s

inherent privacy-preserving techniques.

1 INTRODUCTION

Privacy is a basic human need (Altman, 1976; Doyal,

1997) and it spans all areas of human activity. For

that the concept of privacy is notoriously known as

very difﬁcult to deﬁne (Price and Cohen, 2019). Even

more so, the technological era has given a whole

new meaning to privacy (Hartmann et al., 2022; Koo

et al., 2020). Modern technological solutions, such

as Active Assisted Living technologies, provide great

beneﬁts in healthcare and at the same time posit a

risk of violating privacy. Computer vision advance-

ments gave rise to visual sensing based AAL solu-

https://orcid.org/0000-0001-6255-2095

https://orcid.org/0000-0001-6890-3001

https://orcid.org/0000-0002-4452-635X

https://orcid.org/0000-0002-3391-711X

tions which are further advanced as they register a

great deal of information compared to other sensors,

and allow the analysis of complex scenarios. Hence,

camera-based technologies offer way more ﬂexible

and adaptive solutions to providing care (Colantonio

et al., 2018). With the great beneﬁts of visual data

processing, risks for privacy and data security come

into play, as visual information can be quite sensi-

tive from a technology user perspective. In response

to this, privacy-preserving smart solutions are emerg-

ing. The Privacy by Design paradigm in technology

allows data protection through inherent technology

design (Schaar, 2010). Under this framework differ-

ent visual privacy preservation ﬁlters are being de-

veloped for video-based AAL technologies (Climent-

erez and Florez-Revuelta, 2021; Ravi et al., 2021).

On the other side of these technological advance-

ments is the user perspective. Privacy concerns are

Mujirishvili, T., Richart-Martínez, M., Cabrero-García, J. and Flórez-Revuelta, F.

What Is Privacy? Perceptions of Older Adults in the South of Spain About the Concept of Privacy and in Terms of Video-Based AAL Technologies.

DOI: 10.5220/0011984800003476

In Proceedings of the 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2023), pages 59-64

ISBN: 978-989-758-645-3; ISSN: 2184-4984

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

thought to be one of the main factors affecting the ac-

ceptance of the AAL or technology for aging in place

(Peek et al., 2014; Schomakers and Zieﬂe, 2018;

Wang et al., 2019). However, this statement is a

rather simpliﬁcation of this matter as there are far too

many variables playing a role in this process. A recent

study carried out on 1296 Dutch older adults demon-

strated that participants appraise aging in their pre-

ferred home environment as a valid trade-off for some

loss of privacy, despite having signiﬁcant privacy con-

cerns (Jaschinski et al., 2020). Another recent study

went even further demonstrating that privacy con-

cerns are not as prominent as are beneﬁts of assistive

technology use and revealed its less impact on accep-

tance.(Schomakers and Zieﬂe, 2019). However, there

is a big variety of key factors playing a role in these

ﬁndings, such as age, cultural background and neces-

sity for assistance in the participants, as well as the

technology in the focus of these studies, and the in-

vestigated dimensions of privacy. Understanding and

measuring the concept of privacy already presents a

big challenge in the technological context (Hartmann

et al., 2022).

The aim of the study is to execute primary

exploratory interviews to understand what privacy

means for older adults, and what implications it has

in relation to active assisted living technology in a

Spanish population. We are speciﬁcally interested in

knowing how older adults deﬁne privacy as a concept,

in relation to their lives, and in relation to AAL tech-

nology; What are their attitudes toward AAL tech-

nology and Video-based AAL technology (VAAL)

speciﬁcally and how does it affect their privacy?

2 METHODS

In order to explore the research questions under

the topic of privacy, a qualitative methodological

framework was developed, encompassing primary ex-

ploratory interview sessions with older adults. The

study was approved by the ethical committee of the

University of Alicante.

2.0.1 The Sample

The interview sessions were conducted with 12 older

adults, 66 and plus of age in the southeast of Spain.

The recruitment of the participants was organized us-

ing the help of the case manager from a healthcare

center in Alicante, Spain. A purposive sampling tech-

nique was used to identify respondents in a way that

ﬁtted the different sociodemographic proﬁles. Half of

the respondents were from care homes and half were

from private households in the Valencian province of

Spain. Further sociodemographic characteristics of

participants are displayed in Table 1.

2.0.2 Data Collection and Analysis

Potential respondents from private households were

contacted by their health center case manager and

were informed about the aim of the study. The con-

tact information of those who agreed to participate

was forwarded to the researcher who then followed

them up to schedule interview sessions. Respondents

were visited in their own living spaces by the inter-

viewer. With the consent of the care home man-

ager researcher also visited the care home to inter-

view older adults living there. Each interview session

started with the introduction of the study aim, reading

the information sheet and was followed by the sign-

ing of the consent form. All interview sessions were

audio-recorded. Each session lasted from 30 to 45

minutes. Interview sessions were then transcripted

and the obtained data were analyzed with thematic

analysis (Vaismoradi et al., 2013) using a MAXQDA

2022 qualitative analysis software package (VERBI

Software, ).

2.0.3 The Interview Guide

The interview guide was divided into two category

questions: Privacy and Assistive Technology.

In the ﬁrst part, questions about the concept of pri-

vacy were asked and different aspects of privacy were

discussed. Respondents were presented with different

dimensions of privacy (Physical, Psychological, So-

cial, and Informational Privacy) originally described

Table 1: Sociodemographic characteristics of the participants (n=12).

Age: Median [Min, Max] 77 [66 to 88 years]

Sex 8 Females

Education 3 University graduates, 9 high school graduates

Comfort with Technology: Median [Min, Max] 1 [1, 3]

Health Condition: Median [Min, Max] 4.5 [1, 8]

Comfort with Technology and the Health Condition were measured with simple Likert-like self-assessment scales from 1 to

10.

ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health

by Burgoon and Parrott (Burgoon, 1982; Parrott et al.,

1989), and were asked to deﬁne them. These dimen-

sions with the author-provided deﬁnition are given

in Table 2. We decided to add Nudity as a separate

aspect of the Physical Privacy dimension as nudity

seems to be a very important aspect of privacy, espe-

cially in the AAL and medical care context (Maidhof

et al., 2022; Pupulim and Sawada, 2010), and it shall

not be integrated into general Physical Privacy. Apart

from the four dimensions of privacy we also added

Bystander privacy as the ﬁfth construct, as it comes

as an important player in terms of video-based AAL

technologies (Chowdhury et al., 2016). After the ini-

tial discussion about privacy dimensions, respondents

were provided with the author’s deﬁnition for each di-

mension and were asked to rate on a Likert-like scale

(Jebb et al., 2021) how important each aspect is for

them from 1 to 5, where 1 means “it is not important

at all” and 5 means “It is very important”.

In the second, part participants’ attitudes to-

ward AAL technology (camera-based among them)

in terms of privacy were investigated. Participants

were asked about their knowledge and experience

with AAL technologies. The description and exam-

ples of these technologies were given to the partici-

pants when necessary, from simple emergency alarm

buttons to highly elaborated video-monitoring sys-

tems. Their attitudes about privacy were studied and

the privacy-preserving ﬁlter mechanisms in the case

of the video-monitoring system were explained to

them.

At the end of the interview, together with the

sociodemographic data, respondents’ comfort with

technology and their health conditions were measured

with simple Likert-like self-assessment scales (Jebb

et al., 2021): ”How would you evaluate your comfort

with technology in general (e.g., Smartphone, Laptop,

PC, tablet) on a scale from 1 to 10, where 1 means -

I am very uncomfortable and 10 means - I am very

comfortable”; ”How would you evaluate your current

health condition on a scale from 1 to 10, where 1

means - I am in very poor health and 10 means - I

am in very good health”. Participants were also asked

to indicate if they had any previous experience with

AAL technology.

3 RESULTS

Participants’ characteristics are summarised in Table

1. We have used medians for descriptive statistics, as

medians are likely to be more appropriate than means

in a qualitative study reporting (Bazeley, 2004). Com-

fort with technology, measured with simple Likert-

like self-assessment scales (from 1 to 10, where 1

means - I am very uncomfortable and 10 means - I

am very comfortable) was quite low, (M=1.8; Sd=0.8)

in the sample. Three out of 12 respondents have had

previous experience with the Red Cross Alarm But-

ton, none of them had any previous experience with

video-based AAL monitoring systems and one partic-

ipant knew someone who has had such an experience.

Findings from the interview sessions are summarized

in the two sections below.

3.0.1 What Is Privacy?

Most of the participants had a hard time answering

the question – “What is privacy for you, how would

you deﬁne it?”. Eight out of 12 participants could not

understand what is privacy at ﬁrst and needed further

explanations for it. Three participants (P.1, P.3, P.8)

have mistaken the word ”privacy” for ”deprivation”

(“Privacidad” for “Privar” in Spanish) and required

more clariﬁcations as well. Then again, after further

explanations, they came up with their way of deﬁning

privacy: “Privacy for me is that no one from the street

gets into my private things” – P.11. Some participants

came up with even more elaborate deﬁnitions of it:

“For me, privacy means that my personal data is not

Table 2: Privacy Dimensions (Burgoon, 1982; Parrott et al., 1989).

Physical privacy The degree to which one is physically accessible to

others.

Social privacy Individual’s ability and effort to control social con-

tacts.

Psychological privacy The ability of human beings to control cognitive

and affective inputs and outputs, to form values,

and the right to determine with whom and under

what circumstances they will share thoughts or re-

veal intimate information.

Informational privacy Individual’s right to determine how, when, and to

what extent information about the self will be re-

leased to another person or to an organisation.

What Is Privacy? Perceptions of Older Adults in the South of Spain About the Concept of Privacy and in Terms of Video-Based AAL

Technologies

used in an opportunistic way so that people can not

take advantage of certain things, that nobody inter-

feres too much in my life... so that it is respected and

so on...” – P.12. P.6 gave us a very interesting per-

spective: “Privacy means that I am independent, but

actually I am not anymore, my privacy would be to

do things by myself, but I can not anymore, they [care

home nurses] have to help me - I can’t take a shower

by myself.”

Respondents were also asked to deﬁne different

privacy dimensions i.e. Physical (Nudity as a sepa-

rate dimension of it), Psychological, Social, Informa-

tional Privacy, and Bystander Privacy. Just like about

privacy deﬁnitions, most of the participants had a hard

time thinking of what could mean each dimension of

privacy and coming up with examples around it. Af-

ter the initial discussion about privacy dimensions, re-

spondents were provided with the author’s deﬁnition

for each dimension. The median ratings of the impor-

tance of each dimension (measured on a Likert-like

scale from 1 to 5, where 1 means “it is not important at

all” and 5 means “It is very important”) are presented

in Table 3. Nudity was rated as the most important

across the participants among the presented dimen-

sions and Bystander Privacy was rated as the least im-

portant. Because of the qualitative nature of the study

and the small sample size, it was not possible to calcu-

late if there was a signiﬁcant difference in the ratings

of privacy dimensions between the participants from a

care home and the ones living in private households.

However, it is key to note that there was a big dif-

ference between those two groups of participants in

attitudes towards privacy dimensions and privacy in

general, as expressed in the conversations: ﬁve out of

six participants from care homes noted their percep-

tion shift about nudity and physical privacy since they

moved to the care home: “What can I say about nu-

dity, here they [care home nurses] wash you every day

- the girls, the boys [nurses]. Do not think I liked it

so much at ﬁrst! but then I got used to it, now I don’t

even pay attention to it”- P.3. “There is no privacy

here”- P.4.

3.0.2 Privacy in VAAL Technologies

The second set of questions of the interview was ded-

icated to understanding the participants’ attitudes to-

ward AAL technologies - video-based ones among

them. Participants were asked if they knew what is

assistive technology, after which further explanations

and examples were given on the AAL technologies,

and inquiries about their perceptions were made.

All participants saw assistive technologies as a

generally positive thing, however, two of them raised

trust and data security concerns: P.1 - “I don’t like it

when they tell me one thing and do another, it hap-

pens in every system, in banks too, what if this is the

same”, P.12 - “As long as data is used for good it [as-

sistive technology] is ﬁne, but if they take advantage

of the data then no. For example, you pay for inter-

net and then they use your data you don’t know how”.

P.12 also raised a concern about the fact that access to

assistive technologies can be problematic: - “Some-

times you have to go through so many bureaucratic

procedures that in the end, it is not worth it”.

Speaking of camera-based ALL technology, eight

of 12 participants did not like the idea of having

a video-based assistive technology for themselves.

However, some interesting trends came out in the

conversation. Three of those eight participants saw

camera-based systems as favorable in general, but

they said they do not need it just yet. P.1. – “The

camera is a good technology, nothing against it, emer-

gency help possibility is the biggest advantage of it in

case something happens to someone, but I don’t need

it”. Participants’ reasons for not wanting to have a

camera-based assistive technology were mostly pri-

vacy associated: P.2. - “Cameras are seeing every-

thing, I don’t like it”; P8. - “I prefer not to have the

camera in my room, for example, if I am taking a bath

and they are always looking at me, no, no, in my pri-

vate space they do not interfere!”; P9. - “In a cam-

era, everything is shown”; P.11 - “What I don’t like

is that they know who you are, it scares me, cameras

take away your privacy”; P.12 - “It takes away a lot of

your intimacy, they can see if you are taking a shower,

if you are dressing”. P1. Also raised a concern about

Table 3: Ratings of each privacy dimension (How important is it for you from 1 to 5).

Privacy Dimension Median [Min, Max]

Physical Privacy 3 [2, 5]

Nudity 4.5 [2, 5]

Social Privacy 3 [2, 4]

Psychological Privacy 4 [2, 5]

Informational Privacy 3.5 [1, 5]

Bystander Privacy 2.5 [2, 4]

ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health

feeling ashamed of having a camera: - “It [camera]

would be a shame for me, what do I tell others?!”.

Interestingly, two of the eight participants who

did not like the idea of having a camera-based assis-

tive technology at ﬁrst, changed their ideas after hav-

ing explained to them about so-called Privacy Filters,

which anonymize obtained visual information: P.10

- “I would accept cameras that cover my body, but

that is very difﬁcult to do right?! But I would ac-

cept this”. Participants felt more secure about using

camera-based technology with privacy ﬁlters, how-

ever, trust issues were also raised: P.11 - “I would

always have doubts if they are really doing what they

have told me [in terms of using privacy ﬁlters] or

if they are using your data. You can tell me that I

see this [anonymized images], but how can one be

sure?”. Two participants noted the difﬁculty of rea-

soning about such technologies when they have never

seen it: P.3 - “But here there are no such systems and

how do I imagine it”. P.9. - “If I have never touched

it, I have never seen it, what do you want me to tell

you”.

Four of the eight participants found camera-based

assistive technology acceptable from the beginning,

even if one of them (P.4) said that: “The feeling that

you are being watched is uncomfortable”. Interest-

ingly, all those four participants live in care homes

and are above 80 years old. P.5 had a previous history

of falls and had an experience of using an emergency

button. She found the fall detection ability of the

camera-based system very advantageous: “Camera

will be for good, if I fall, I don’t have to think about

anything”. P.7 expressed that he would not mind be-

ing watched with a camera because: “They [cameras]

are watching me to help me”. P.6 from the care home

also shared with us an interesting view in terms of

privacy: “I do not see anything wrong with cameras, I

no longer have the freedom of no one seeing me in the

bathroom, for example, so cameras would not violate

my privacy”. It is important to note that a contrasting

view also was presented by the P.3, when he noted

that: “Here there are always the same girls or boys

[nurses at the care home] and you are already used

to it and with cameras, I wouldn’t be at ease because

everybody sees you”.

4 DISCUSSION

Findings indicate that the concept of privacy is

not readily understandable for older adults, however

when mentioned in the context of video-based moni-

toring systems, then they do get alarmed. Hence re-

searchers shall be very cautious when measuring this

construct. It was very surprising when three respon-

dents mistook the word ”privacy” for ”deprivation”

(“Privacidad” for “Privar” in Spanish), however, in-

terestingly enough, the etymology of the term ”pri-

vacy” can be traced back to the Latin words ”priva-

tus” (Curtin, 1981) and “privo”, meaning “to deprive”

(Rawnsley, 1980). Its original usage pertained to the

military term ”private,” which denoted the act of be-

ing deprived of status or rank ’(Leino-Kilpi et al.,

2001). This has been a very thought-provoking co-

incidence (or not a coincidence) which has led us to

think that one´s privacy is indeed a very sensitive

matter which can lead to a loss of power and sta-

tus (“to be deprived of status or rank”) when com-

promised. This historical connotation of the term

prompts contemplation on the nature of privacy and

the potential consequences of unwanted access. The

concept of privacy is closely intertwined with the no-

tions of autonomy, inﬂuence, and independence. With

further studies, we wish to inquire whether privacy

and independence lie on the same continuum or are

oppositional in terms of AAL technologies. On one

hand, participants stated that privacy for them means

independence, but they no longer have the autonomy

of privacy. On the other hand, modern technologies

seem to be offering us increased independence at the

expense of risking privacy. Hence, the question is,

can technologies guarantee data security and privacy

together with increased independence.

Interview sessions demonstrated that nudity can

be one of the most important aspects of privacy for

older people, however, perceptions of nudity defer be-

tween people living in their private households and

care homes - with the latter group stating that they

already do not have the physical privacy. Likewise,

people from care homes tend to be more accepting

of video-based AAL technologies, which again could

be associated with the existing lack of privacy in care

homes. However, we need to be very careful with

this statement and further studies need to be done

to closely understand this matter. Findings indicate

that data security and trust are the main issues with

the AAL technology and admittedly in the VAAL

systems privacy comes into play. Interviews also

showed a positive attitudinal shift for VAAL once vi-

sual anonymization was offered to the respondents.

However, they reasonably stated that it is very difﬁ-

cult to imagine mentioned privacy ﬁlters without at

hand experience.

This exploratory qualitative study comes with a lot

of limitations associated with the chosen study de-

sign and not only. The sample size is fairly small

(n=12), even if this was a pilot study and we con-

ducted the interviews until the saturation of informa-

What Is Privacy? Perceptions of Older Adults in the South of Spain About the Concept of Privacy and in Terms of Video-Based AAL

Technologies

tion was reached. The sample is from a small urban

area in the south of Spain and cannot be generalized to

a bigger population and cross-culturally. Participants

of the interviews did not have any direct contact or

experience with the AAL technology they were inter-

viewed about, nor about the proposed privacy ﬁlters,

they were simply given explanations of it. However,

this study has been insightful in grasping what older

adults understand about the concept of privacy and

AAL technology as the ﬁrst stage. This leads us to

future studies with a more sophisticated methodology

and integrated at-hand experience with the proposed

AAL technologies.

ACKNOWLEDGEMENTS

This work is funded by the European Union’s Horizon

2020 research and innovation programme under the

Marie Sklodowska-Curie grant agreement No 861091

for the visuAAL project.

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ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health